Drug-resistant TB treatment at home

The new treatment modality was initiated on Tuesday with the introduction of a new WHO-approved diagnostic machine GeneXpert that will identify the multi-drug resistant TB (MDR TB) within two hours.

It now takes two months to diagnose TB that does not respond to any of the most effective antibiotics –Isoniazide and Rifampicin, and a patient has to stay more than six months in hospital in its 20 to 24 months treatment period.

In the new home-based management system, according to National TB Programme (NTP), an MDR TB patient can take drugs at home only after one or two months of hospital stay if the sputum tested negative to the organism. A trained team would ensure the medication at home.

Launching the new initiatives supported by USAID in Dhaka, Health and Family Welfare Minister AFM Ruhal Haque said "it's a milestone" in MDR TB management. USAID Bangladesh Mission Director Richard Greene handed over a GeneXpert machine to the minister.

Tuberculosis, caused by the organism Mycobacterium tuberculosis, can be fatal but is curable with a set of antibiotics, experts say.

Multi-drug resistant forms of TB developed because of inappropriate or incomplete treatment, which is highly fatal and could pass on from one individual to another.

The fatality rate of MDR TB is five times higher than the usual forms of TB – lung TB or otherwise.

According to British medical journal The Lancet it is increasing worldwide.

In the new policy, field staff will administer rest of the regimen of drugs at home in a procedure WHO called DOTS (Directly Observed Therapy, Short-course).

NTP's Line Director Dr Md Ashaque Husain said the new system would benefit MDR TB patients as only 162 beds in two infectious diseases hospitals in Dhaka and Chittagong have to grapple to mange patients.

"The two hospitals can only manage 400 such patients a year leaving many waited outside."

He said the new management would reduce hospital stay as well as overall management costs and hospital acquired infections of those immune-compromised TB patients. The rest of the treatment would continue at home under close observation of outpatient MDR TB team and drugs would be ensured by trained healthcare providers.

Husain, however, said it would be a challenge to form the team.

Speaking at the launching ceremony, the health minister asked for close monitoring of the programme and suggested training of doctors for 'effective management' of MDR TB.

Studies show that people with weaker economic background – with a monthly income of less than Tk 3,000 and with no education – are more at risk of getting TB than others.